Targeting intolerance of uncertainty in young children diagnosed with autism: A randomized controlled trial of a parent-mediated group intervention

Abstract

Background

Young children diagnosed with autism experience high rates of co-occurring anxiety, with uncertainty-related concerns commonly reported. This randomized controlled trial investigated an 8-week parent-mediated group anxiety intervention, “Coping with Uncertainty in Everyday Situations” (CUES-Junior©).

Methods

Parents of 4–7-year-old children diagnosed with autism and experiencing uncertainty-related anxiety were recruited. The primary outcome was change from baseline in blinded assessor ratings of child responses to uncertainty and impact on family, measured post-intervention and 2-month follow-up. Secondary outcomes were parent-reported child anxiety and intolerance of uncertainty (IU), parental IU and mental health, parenting sense of competence, along with intervention feasibility and acceptability.

Results

Sixty-four children were randomized to CUES-Junior© (n = 33) or waitlist (n = 31); five families withdrew post-randomization. Immediately post-intervention, significantly more CUES-Junior© participants were rated as clinically improved from baseline in child responses to uncertainty (OR = 34.48; 95% CI = 1.72–690.04, p = 0.02) and in family impact (OR = 8.99; 95% CI = 1.52–53.05, p = 0.02) compared to waitlist. Significant improvements were also observed in parent-reported child IU and parenting satisfaction, favoring CUES-Junior©. At subsequent 2-month follow-up, CUES-Junior© participants showed sustained improvements in the impact of uncertainty on children, and parental ratings of child IU and anxiety, parenting sense of competence, and parental stress, compared to baseline. The program was feasible to administer and acceptable to parents.

Conclusions

CUES-Junior© had an immediate treatment effect on child responses to uncertain situations and impact on families, with maintained improvements observed at follow-up. This novel mechanism-targeted and autism-informed program holds promise for addressing early uncertainty-related anxiety in young children diagnosed with autism.